Provider Demographics
NPI:1528061256
Name:FLOURNOY, DURWOOD W (MD)
Entity type:Individual
Prefix:
First Name:DURWOOD
Middle Name:W
Last Name:FLOURNOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W TUCKER RD
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-6937
Mailing Address - Country:US
Mailing Address - Phone:270-247-9496
Mailing Address - Fax:270-247-7780
Practice Address - Street 1:1111 MEDICAL CENTER CIR
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-1194
Practice Address - Country:US
Practice Address - Phone:270-247-8100
Practice Address - Fax:270-247-7780
Is Sole Proprietor?:No
Enumeration Date:2005-05-26
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31291207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64312911Medicaid
KY1318602Medicare PIN
KY64312911Medicaid